Immune Globulins
L34771
Immune globulins (IV, IM, subQ) are covered for specific post-exposure prophylaxis (e.g., hepatitis A/B, measles, rubella, rabies, vaccinia, tetanus, varicella in high-risk patients), for primary humoral immunodeficiencies, select autoimmune and hematologic conditions (with severity/refractoriness requirements), and for certain transplant and neonatal indications. Coverage includes specific product-based indications (e.g., CMV-IGIV for transplant prophylaxis, HepaGam B for HBV exposures, CroFab for crotalid envenomation, Hyqvia for adult primary immunodeficiency) and contains defined documentation and timing requirements (e.g., measles <3 days, CroFab <6 hours, tetanus wound criteria). Experimental use (e.g., IVIG desensitization for PRA 81–100%) is not covered and Hyqvia Part B 'incident to' teaching is limited to two office episodes before DME MAC billing applies.
"Intramuscular immune globulin (gamma globulin) is indicated for post-exposure prophylaxis to hepatitis A."